Agreement of high definition oscillometry with direct arterial blood pressure measurement at different blood pressure ranges in horses under general anaesthesia

ObjectiveTo determine the agreement of high definition oscillometry (HDO) with direct arterial blood pressure measurements in normotensive, hypotensive and hypertensive horses during general anaesthesia.Study designExperimental study.AnimalsSeven healthy warmblood horses, aged 3–11 years, weighing 470–565 kg.MethodsMeasurements from a HDO device with the cuff placed around the base of the tail were compared with pressures measured invasively from the facial artery. High blood pressures were induced by intravenous (IV) administration of dobutamine (5 μg kg⁻¹ minute⁻¹) over ten minutes followed by norepinephrine (0.1 mg kg⁻¹ IV) and low pressures by increasing the inspired fraction of isoflurane and administration of nitroglycerine (0.05 mg kg⁻¹ IV). For analysis three pressure levels were determined: high (MAP>110 mmHg), normal (60 mmHgResultsA total of 245 paired measurements of systolic (SAP), mean (MAP) and diastolic (DAP) pressures were obtained. The HDO device underestimated blood pressure at hypertensive and normotensive levels and overestimated blood pressure at hypotensive levels. Best agreement was obtained for SAP and MAP within normotensive limits. At normotension, bias ± standard deviation for SAP, MAP and DAP were 0.1 ± 19.4 mmHg, 0.5 ± 14.0, 4.7 ± 15.6, respectively. At high pressure levels bias and SD were 26.1 ± 37.3 (SAP), 4.2 ± 19.4 (MAP), 1.5 ± 16.8 (DAP) and at low pressures -20.0 ± 20.9 (SAP), -11.4 ± 19.6 (MAP), -4.7 ± 20.1 (DAP), with HDO measurements at a MAP <50 mmHg often failing.Conclusion and clinical relevanceGood agreement with invasive arterial blood pressures was obtained with HDO at normotensive levels in horses. At high and low pressure ranges HDO was unreliable. Therefore, if haemodynamic instability is expected, invasive measurement remains preferable.     

Effects of head position on internal and external carotid pressures in standing sedated horses

The effects of head position on internal carotid artery (ICA) and external carotid artery (ECA) pressures in standing sedated horses were evaluated in this study. The common carotid artery (CCA) was catheterized in 6 horses using an ultrasound-guided technique to facilitate placement of a pressure transducer within the ICA and ECA at the level of the guttural pouch. Transducer position was confirmed by endoscopic visualization. Mean arterial pressure (MAP) was measured with horses in both a head-up and head-down position. The dorsal metatarsal artery was catheterized as a control. Maintaining a head-up position decreased MAP in both the ICA (median: 75.21 mmHg) and ECA (median: 79.43 mmHg), relative to the head-down position (ICA median: 104.65 mmHg; ECA median: 102.26 mmHg). Mean arterial pressure in the dorsal metatarsal artery was not affected by head position. The head-up position resulted in lower arterial pressures in both the ICA and ECA (P = 0.03) compared with the head-down position in standing sedated horses.     

Assessing the Association Between Hoof Thermography and Hoof Doppler Ultrasonography for the Diagnosis of Lameness in Horses

The objectives of this study were to assess the correlation between hoof surface temperature and ultrasonographic measurements of digital blood vessels in horses and to evaluate the measurements' potential as predictors for clinical lameness. Twelve 3-year-old American Quarter Horses, 6 geldings and 6 mares, with average initial body weight of 459 ± 31 kg were used. On days 0, 30, 60, and 90 of the study, horses were weighed and subjected to clinical lameness examinations. Doppler ultrasonography was used to measure diameter of the medial palmar artery in the distal left forelimb and velocity of blood flow through that artery, starting at 60 minutes after morning feeding and repeated at 30-minute intervals. Temperature measurements on the hoof were collected at 15-minute intervals beginning 75 minutes after feeding, using a digital thermographic camera. A series of bivariate linear mixed models were fitted to estimate the correlation between Doppler and temperature measurements. The within-horse and between-horse correlations between hoof surface temperature and velocity of blood flow in the distal limb through the medial palmar artery was estimated at 0.40 (P > .50) and 0.99 (P < .001), respectively. These results indicate that at the horse level, the correlation between hoof temperature and velocity of blood flow in the distal limb was very high but that the within-horse correlation was not significantly different from 0. Velocity of blood flow at 60 minutes after feeding improved model fit to the lameness data, so it was included as a model predictor for lameness.     

The effect of frog pressure and downward vertical load on hoof wall weight-bearing and third phalanx displacement in the horse--an in vitro study

A shoe was designed to combine the advantages of a reverse shoe and an adjustable heart bar shoe in the treatment of chronic laminitis. This reverse even frog pressure (REFP) shoe applies pressure uniformly over a large area of the frog solar surface. Pressure is applied vertically upward parallel to the solar surface of the frog and can be increased or decreased as required. Five clinically healthy horses were humanely euthanased and their dismembered forelimbs used in an in vitro study. Frog pressure was measured by strain gauges applied to the ground surface of the carrying tab portion of the shoe. A linear variable distance transducer (LVDT) was inserted into a hole drilled in the dorsal hoof wall. The LVDT measured movement of the third phalanx (P3) in a dorsopalmar plane relative to the dorsal hoof wall. The vertical component of hoof wall compression was measured by means of unidirectional strain gauges attached to the toe, quarter and heel of the medial hoof wall of each specimen. The entire limb was mounted vertically in a tensile testing machine and submitted to vertical downward compressive forces of 0 to 2,500 N at a rate of 5 cm/minute. The effects of increasing frog pressure on hoof wall weight-bearing and third phalanx movement within the hoof were determined. Each specimen was tested with the shoe under the following conditions: zero frog pressure; frog pressure used to treat clinical cases of chronic laminitis (7 N-cm); frog pressure clinically painful to the horse as determined prior to euthanasia; frog pressure just alleviating this pain. The specimens were also tested after shoe removal. Total weight-bearing on the hoof wall at zero frog pressure was used as the basis for comparison. Pain-causing and pain-alleviating frog pressures decreased total weight-bearing on the hoof wall (P < 0.05). Frog pressure of 7 N-cm had no statistically significant effect on hoof wall weight-bearing although there was a trend for it to decrease as load increased. Before loading, the pain-causing and pain-alleviating frog pressures resulted in a palmar movement of P3 relative to the dorsal hoof wall compared to the position of P3 at zero frog pressure (P < 0.05). This difference remained statistically significant up to 1300 N load. At higher loads, the position of P3 did not differ significantly for the different frog pressures applied. It is concluded that increased frogpressure using the REFP shoe decreases total hoof wall weight-bearing and causes palmar movement of P3 at low weight-bearing loads. Without a shoe the toe and quarter hoof wall compression remained more constant and less in magnitude, than with a shoe.     

Agreement between invasive blood pressures measured in three peripheral arteries in anaesthetized horses under clinical conditions

Objective

To determine agreement between invasive blood pressures measured in three peripheral arteries in anaesthetized horses undergoing elective surgery.

Wedge and Eggbar Shoes Change the Pressure Distribution Under the Hoof of the Forelimb in the Square Standing Horse

The shoe types most commonly applied to horses with navicular disease or other forms of palmar heel pain are shoes with heel wedges and eggbar shoes, although their efficacy has been a matter of debate among veterinarians and farriers for centuries. To quantify the effect of these different types of “navicular” shoeing on static hoof pressure distribution, 6 warmblood horses were shod with 6° wedge, eggbar, and plain shoes. While standing square with weight evenly distributed across both forelimbs, the center of pressure and pressures at selected areas of interest (AOI: toe, medial and lateral toe, medial and lateral heel) were measured using a Footscan (RsScan International, Belgium) pressure plate in a Latin square design using the plain shoe as a reference.Wedge shoes did not provide a significant shift in the center of pressure. The application of eggbar shoes did not alter the relative position of the center of pressure under the hoof. However, the absolute distance from the toe to the center of pressure was significantly larger with eggbar shoes (77 + 12 mm) compared with plain and wedged shoes (70 ± 8 mm, P < .05) resulting in an absolute, caudal shift of the center of pressure. When pressure (N/cm²) values at the five AOIs were averaged for each shoe type, the wedge and eggbar shoe recordings showed a significantly lower mean pressure than plain shoes (P < .05).In conclusion, mean AOI pressures decreased with wedge and eggbar shoes, and eggbar shoes provided a caudal shift in the center of pressure. These effects are believed to decrease the moment of the coffin joint and reduce the pressure on the navicular bone. Thus, the findings of this study might contribute to the scientific evidence of efficacy of the use of wedge and eggbar shoes in “navicular” lame horses.     

A study of measurement of noninvasive blood pressure with the oscillometric device,Sentinel, in isoflurane‐anaesthetized horses

ObjectiveTo assess accuracy of noninvasive blood pressure (NIBP) measured by oscillometric device Sentinel compared to invasive blood pressure (IBP) in anaesthetized horses undergoing surgery. To assess if differences between the NIBP measured by the Sentinel and IBP are associated with recumbency, cuff placement, weight of the horse or acepromazine premedication and to describe usefulness of the Sentinel.Study designProspective study examining replicates of simultaneous NIBP and IBP measurements.AnimalsTwenty-nine horses.MethodsInvasive blood pressure was measured via a catheter in the facial artery, transverse facial artery or metatarsal artery. NIBP was measured using appropriate size cuffs placed on one of two metacarpal or metatarsal bones or the tail in random order. With both techniques systolic (SAP), mean (MAP), and diastolic (DAP) arterial blood pressures and heart rates (HR) were recorded. A mixed effects model compared the IBP to the NIBP values and assessed potential effects of catheter placement, localisation of the cuffs in combination with recumbency, weight of the horse or acepromazine premedication.ResultsNoninvasive blood pressure yielded higher measurements than IBP. Agreement varied with recumbency and cuff position. Estimated mean differences between the two methods decreased from SAP (lateral recumbency: range -5.3 to -56.0 mmHg; dorsal recumbency: range 0.8 to -20.7 mmHg), to MAP (lateral recumbency: range -1.8 to -19.0 mmHg; dorsal recumbency: range 13.9 to -16.4 mmHg) to DAP (lateral recumbency: range 0.5 to -6.6 mmHg; dorsal recumbency: range 21.0 to -15.5 mmHg). NIBP measurement was approximately two times more variable than IBP measurement. No significant difference between IBP and NIBP due to horse's weight or acepromazine premedication was found. In 227 of 1047 (21.7%) measurements the Sentinel did not deliver a result.Conclusion and clinical relevanceAccording to the high variability of NIBP compared to IBP, NIBP measurements as measured by the Sentinel in the manner described here are not considered as an appropriate alternative to IBP to measure blood pressure in anaesthetized horses.     

Clinical evaluation of the Surgivet V60046, a non invasive blood pressure monitor in anaesthetized dogs

OBJECTIVE: To compare the performance of the Surgivet Non-Invasive Blood Pressure (NIBP) monitor V60046 with an invasive blood pressure (IBP) technique in anaesthetized dogs. STUDY DESIGN: A prospective study. ANIMALS: Thirty-four dogs, anaesthetized for a variety of procedures. METHODS: Various anaesthetic protocols were used. Invasive blood pressure measurement was made using a catheter in the femoral or the pedal artery. A cuff was placed on the contralateral limb to allow non invasive measurements. Recordings of arterial blood pressures (ABPs) were taken at simultaneous times for a range of pressures. For analysis, three pressure levels were determined: high [systolic blood pressure (SAP) > 121 mmHg], normal (91 mmHg < SAP < 120 mmHg) and low (SAP < 90 mmHg). Comparisons between invasive and non invasive measurements were made using Bland-Altmann analysis. RESULTS: The NIBP monitor consistently underestimated blood pressure at all levels. The lowest biases and greatest precision were obtained at low and normal pressure levels for SAP and mean arterial pressure (MAP). At low blood pressure levels, the biases +/- 95% confidence interval (CI) were 1.9 +/- 2.96 mmHg (SAP), 8.3 +/- 2.41 mmHg diastolic arterial pressure (DAP) and 3.5 +/- 2.09 mmHg (MAP). At normal blood pressure levels, biases and CI were: 1.2 +/- 2.13 mmHg (SAP), 5.2 +/- 2.32 mmHg (DAP) and 2.1 +/- 1.54 mmHg (MAP). At high blood pressure levels, the biases and CI were 22.7 +/- 5.85 mmHg (SAP), 5.5 +/- 3.13 mmHg (DAP) and 9.4 +/- 3.52 mmHg (MAP). In 90.6% of cases of hypotension (MAP < 70 mmHg), the low blood pressure was correctly diagnosed by the Surgivet. CONCLUSIONS: Measurement of blood pressure with the indirect monitor allowed detection of hypotension using either SAP or MAP. The most accurate readings were determined for MAP at hypotensive and normal levels. The monitor lacked accuracy at high pressures. CLINICAL RELEVANCE: When severe challenges to the cardiovascular system are anticipated, an invasive method of recording ABP is preferable. For routine usage, the Surgivet monitor provided a reliable and safe method of NIBP monitoring in dogs, thereby contributing to the safety of anaesthesia by providing accurate information about the circulation.     

Clinical observations surrounding an increased incidence of postanesthetic myopathy in halothane-anesthetized horses

BACKGROUND: During an 8-year period of clinic improvements, an increased incidence of postanesthetic myopathy (PAM) was observed in horses undergoing anesthesia. A request was made for an independent anesthesiologist to examine possible reasons for this increase. Routine methods used for anesthesia were then compared with new methods introduced by the anesthesiologist. OBSERVATIONS: Investigative observations were conducted from October 1999 to April 2000. Following premedication with xylazine or detomidine, anesthesia was induced with diazepam or guiaifenesin followed by ketamine. Maintenance of anesthesia was with halothane/O(2) with mechanical ventilation. Information was gathered from observing routine anesthetics. Seventeen horses were designated group A (October-December 1999) for which hypotension was defined as mean arterial pressure (MAP) <60 mmHg and managed using low-volume crystalloid fluid therapy, etilefrine, or dopamine. In the next 18 horses (group B), hypotension was redefined as MAP <70 mmHg, and was managed using high-volume fluid therapy and dobutamine (January-April 2000). No other changes were made. In both groups, creatine kinase (CK) and aspartate transaminase (AST) concentrations were measured before induction, 1 and 25 hours after standing. Occurrence of PAM was defined as CK and/or AST concentrations above 1000 IU L(-1) and analyzed with Fisher's exact test between groups. Muscle enzymes increased in five horses in group A (two with clinical signs) and in one horse in group B (difference between groups: p = 0.088). CONCLUSIONS: Maintaining MAP >70 mmHg with high-volume fluid therapy and dobutamine may help to reduce the severity of myopathy.     

Differences in need for hemodynamic support in horses anesthetized with sevoflurane as compared to isoflurane

OBJECTIVE: To study whether hemodynamic function in horses, particularly mean arterial blood pressure (MAP), is better maintained with sevoflurane than isoflurane, thus requiring less pharmacological support. STUDY DESIGN: Prospective randomized clinical investigation. Animals Thirty-nine racehorses undergoing arthroscopy in lateral recumbency. METHODS: Horses were assigned to receive either isoflurane (n = 20) or sevoflurane (n = 19) at 0.9-1.0 minimum alveolar concentration (MAC) for maintenance of anesthesia. Besides routine clinical monitoring, cardiac output (CO) was measured by lithium dilution. Hemodynamic support was prescribed as follows: when MAP decreased to <70 mmHg, patients were to receive infusion of 0.1% dobutamine, which was to be discontinued at MAP >85 mmHg or heart rate >60 beats minute(-1). Statistical analysis of results, given as mean +/- SD, included a clustered regression approach. RESULTS: Average inhalant anesthetic time [91 +/- 35 (isoflurane group) versus 97 +/- 26 minutes (sevoflurane group)] and dose (in MAC multiples), volume of crystalloid solution infused, and cardiopulmonary parameters including CO were similar in the two groups, except heart rate was 8% higher in isoflurane than sevoflurane horses (p < 0.05). To maintain MAP >70 mmHg, isoflurane horses received dobutamine over a significantly longer period (55 +/- 26 versus 28 +/- 21% of total anesthetic time, p < 0.01) and at a 51% higher dose than sevoflurane horses (41 +/- 19 versus 27 +/- 23 microg kg(-1) MAC hour(-1); p = 0.058), with 14/20 isoflurane animals and only 9/19 sevoflurane horses being infused with dobutamine at >30 microg kg(-1) MAC hour(-1) (p < 0.05). Dobutamine infusion rates were consistently lower in the sevoflurane as compared to the isoflurane group, with differences reaching significance level during the 0-30 minutes (p < 0.01) and 61-90 minutes periods (p < 0.05). CONCLUSIONS AND CLINICAL RELEVANCE: Horses under sevoflurane anesthesia may require less pharmacological support in the form of dobutamine than isoflurane-anesthetized horses. This could be due to less suppression of vasomotor tone.     

A study of cardiovascular function under controlled and spontaneous ventilation in isoflurane–medetomidine anaesthetized horses

Objective To determine, in mildly hypercapnic horses under isoflurane–medetomidine balanced anaesthesia, whether there is a difference in cardiovascular function between spontaneous ventilation (SV) and intermittent positive pressure ventilation (IPPV). Study design Prospective randomized clinical study. Animals Sixty horses, undergoing elective surgical procedures under general anaesthesia: ASA classification I or II. Methods Horses were sedated with medetomidine and anaesthesia was induced with ketamine and diazepam. Anaesthesia was maintained with isoflurane and a constant rate infusion of medetomidine. Horses were assigned to either SV or IPPV for the duration of anaesthesia. Horses in group IPPV were maintained mildly hypercapnic (arterial partial pressure of carbon dioxide (PaCO₂) 50–60 mmHg, 6.7–8 kPa). Mean arterial blood pressure (MAP) was maintained above 70 mmHg by an infusion of dobutamine administered to effect. Heart rate (HR), respiratory rate (f_R), arterial blood pressure and inspiratory and expiratory gases were monitored continuously. A bolus of ketamine was administered when horses showed nystagmus. Cardiac output was measured using lithium dilution. Arterial blood‐gas analysis was performed regularly. Recovery time was noted and recovery quality scored. Results There were no differences between groups concerning age, weight, body position during anaesthesia and anaesthetic duration. Respiratory rate was significantly higher in group IPPV. Significantly more horses in group IPPV received supplemental ketamine. There were no other significant differences between groups. All horses recovered from anaesthesia without complications. Conclusions There was no difference in cardiovascular function in horses undergoing elective surgery during isoflurane–medetomidine anaesthesia with SV in comparison with IPPV, provided the horses are maintained slightly hypercapnic. Clinical relevance In horses with health status ASA I and II, cardiovascular function under general anaesthesia is equal with or without IPPV if the PaCO₂ is maintained at 50–60 mmHg.     

A clinical comparison between a non‐invasive blood pressure monitor using high definition oscillometry (Memodiagnostic MD 15/90 Pro) and invasive arterial blood pressure measurement in anaesthetized dogs

ObjectiveTo compare high definition oscillometry (HDO) to invasive blood pressure measurement in anaesthetized dogs.Study designProspective, clinical trial.AnimalsFifty dogs weighing 1.95–79 kg (mean 23.5 kg).Materials and methodsAnaesthetic and peri–anaesthetic management was chosen according to each dog's physical status and anaesthetist's preference. Direct arterial blood pressure measurements were performed using a catheter placed in the dorsal pedal artery and an electronic pressure transducer connected to a multiparameter monitor. Non–invasive blood pressure measurements were performed using an appropriately sized cuff placed around the tail base. Comparisons between the two methods were made using Bland and Altman plots. The data are reported as mean bias (lower, upper limits of agreement). Further analysis was performed after separating the data into the following categories based on invasive mean arterial blood pressure (MAP): high (MAP > 100 mmHg), medium (70 mmHg < MAP < 100 mmHg) and low (MAP < 70 mmHg) blood pressure (BP). The two methods were compared as used clinically.ResultsEight hundred measurement pairs for invasive and HDO BP readings were compared. Overall, the HDO measured lower values for SAP and DAP but higher for MAP than the invasive method. The lowest bias (upper, lower limits of agreement) were obtained for MAP, ?1 (?22, 19) mmHg. The biggest discrepancy between the methods was reflected by a large bias (limits of agreement) 5 (?34, 45) mmHg, was for SAP. The results for DAP were between those for SAP and MAP with a bias (limits of agreement) of 3 (?20, 27) mmHg. When the values were separated into the pressure range categories the HDO measured higher in the high, medium and low BP groups, with the exception of SAP in the low BP group.ConclusionsWhen considering the mean bias, the accuracy of HDO compared well with direct arterial blood pressure, but the precision was poor, as determined by wide limits of agreement.Clinical relevanceUsing trends and serial measurements rather than a single measurement for clinical decision making is recommended with both methods, when used as reported here.     

The impact of endophyte-infected fescue consumption on digital circulation and lameness in the distal thoracic limb of the horse

This experiment was conducted to evaluate if consumption of endophyte-infected fescue alters digital circulation in the distal thoracic limb of the horse and to assess if soundness of the hooves of horses is affected by consumption of endophyte-infected fescue. Twelve American Quarter Horses (mean initial BW 459 ± 31 kg), 6 mares and 6 geldings, were used in this 90-d study that comprised high-endophyte (E+) and low-endophyte (E-) treatment groups. Fescue seed was integrated into the E+ diet at a rate sufficient to bring total ergovaline to 200 μg/kg, and endophyte-free fescue seed was incorporated into the E- diet from d 0 to 90. From d 30 to 60, native prairie hay was replaced with high- or low-endophyte fescue hay, bringing total dietary ergovaline to 280 μg/kg (E+) and 18 μg/kg (E-). From d 61 to 90, fescue seed was ground to decrease particle size. On d 0, 30, 60, and 90, Doppler ultrasonography and thermographic imaging were used to measure the diam. of the medial palmar artery, velocity of blood flow, and surface temperature of the hoof as indicators of digital circulation. Lameness examinations were conducted on the same days. There were no consistent treatment differences observed when evaluating measurements of digital circulation. On d 60, horses in the E+ treatment group showed increased hoof sensitivity in the left limb (P = 0.02). These horses tended to have increased hoof sensitivity when both thoracic limbs were averaged (P = 0.06), and they demonstrated increased lameness during longeing (P = 0.08). Data indicated that mares may have increased digital circulation, regardless of treatment, compared with geldings (P ≤ 0.05). Heavier horses also had greater arterial diam., velocity of blood flow, and hoof temperature than lighter BW horses (P ≤ 0.05) on d 30, 60, and 90 at time points that ranged from 90 to 180 min after feeding. Although horses consuming the E+ diet demonstrated increased lameness, especially on d 60, compared with horses consuming the E- diet, the measures of digital circulation did not support the hypothesis that digital circulation was reduced. Because of observed lameness issues, limiting the access of horses to endophyte-infected fescue may be prudent.     

Correlational Characteristics of Hoof Conformation and Midstance Kinetics at Walk

Variations in hoof conformation may alter stress distribution, thus predisposing horses to pathologies and lameness; however, experimental studies are scarce. Our objective was to investigate the correlation between midstance hoof kinetics at the walk and hoof conformation in horses. Nine clinically sound, unshod horses were walked over a pressure plate, and force (F), contact area (CA), contact pressure (CP), and peak contact pressure (PCP) were recorded at the dorsal, palmar, medial, and lateral regions, as well as for the whole hoof. By using digital radiography and digital pictures, 55 variables of internal and external hoof shape and dimensions of the hoof were measured. Correlations between kinetic and anatomical measurements were investigated using Pearson correlation coefficient. P-values ≤ 0.05 and r values ≥ 0.5 were considered. Several anatomical variables showed correlations with biomechanical variables. Toe angle was negatively correlated with CA (r = –0.72). Several heel height measurements were negatively correlated with dorsal F (–0.59 ≤ r ≤ –0.50), suggesting a trend. Measurements of the dorsal hoof wall thickness and length/width of the distal phalanx showed correlations with F and CP (0.5 ≤ r ≤ 0.71). Our study was focused on midstance biomechanics and at the walk; further investigation on other gaits and parts of the stance phases is warranted. Patterns of correlations between internal structural arrangement and hoof kinetic parameters encourage more research and should be considered by veterinarian and farriers for routine and therapeutic trimming/shoeing.     

Agreement between direct, oscillometric and Doppler ultrasound blood pressures using three different cuff positions in anesthetized dogs

ObjectiveTo evaluate the agreement between invasive blood pressure (IBP) and Doppler ultrasound blood pressure (DUBP) using three cuff positions and oscillometric blood pressure (OBP) in anesthetized dogs.Study designProspective study.AnimalsNine adult dogs weighing 14.5–29.5 kg.MethodsThe cuff was placed above and below the tarsus, and above the carpus with the DUBP and above the carpus with the OBP monitor. Based on IBP recorded via a dorsal pedal artery catheter, conditions of low, normal, and high systolic arterial pressures [SAP (mmHg) <90, between 90 and 140, and >140, respectively] were induced by changes in isoflurane concentrations and/or dopamine administration. Mean biases ± 2 SD (limits of agreement) were determined.ResultsAt high blood pressures, regardless of cuff position, SAP determinations with the DUBP underestimated invasive SAP values by more than 20 mmHg in most instances. With the DUBP, cuff placement above the tarsus yielded better agreement with invasive SAP during low blood pressures (0.2 ± 16 mmHg). The OBP underestimated SAP during high blood pressures (?42 ± 42 mmHg) and yielded better agreement with IBP for mean (MAP) and diastolic (DAP) arterial pressure measurements [overall bias: 2 ± 15 mmHg (MAP) and 0.2 ± 16 mmHg (DAP)].ConclusionsAgreement of SAP determinations with the DUBP is poor at SAP > 140 mmHg, regardless of cuff placement. Measurement error of the DUBP with the cuff placed above the tarsus is clinically acceptable during low blood pressures. Agreement of MAP and DAP measurements with this OBP monitor compared with IBP was clinically acceptable over a wide pressure range.Clinical relevanceWith the DUBP device, placing the cuff above the tarsus allows reasonable agreement with IBP obtained via dorsal pedal artery catheterization. Only MAP and DAP provide reasonable estimates of direct blood pressure with the OBP monitor evaluated.     

Evaluation of the tongue for oscillometric measurement of arterial pressure in anesthetized Beagle dogs

ObjectiveTo evaluate the agreement between oscillometric blood pressure (OBP) measured from the tongue and invasive blood pressure (IBP), and to compare OBPs measured from the tongue with OBPs measured from the pelvic limb and tail.Study designProspective experimental study.AnimalsA total of eight adult Beagle dogs weighing 11.1 ± 1.2 kg.MethodsAnimals were premedicated with intravenous (IV) acepromazine (0.005 mg kg^–1). Anesthesia was induced with alfaxalone (3 mg kg^–1) IV and maintained with isoflurane. The dorsal pedal artery was catheterized for IBP measurements. Systolic (SAP), diastolic (DAP) and mean (MAP) arterial pressure were simultaneously measured from the tongue, pelvic limb and tail. Based on invasive SAP, hypertension (>140 mmHg), normotension (90–140 mmHg) and hypotension (<90 mmHg) were induced by controlling end-tidal isoflurane concentrations and/or dobutamine/dopamine administration. Agreement between paired IBP and OBP measurements was analyzed with reference standards for noninvasive blood pressure devices used in small animals and humans.ResultsRegardless of cuff placement, the mean bias ± standard deviation between IBP and OBP met veterinary (≤10 ± 15 mmHg) and human (<5 ± 8 mmHg) standards for MAP and DAP. SAP measurements provided by the OBP device showed unacceptable agreement with IBP, and the bias between methods increased at higher blood pressures, regardless of cuff site. During hypotension, tongue OBP showed the largest percentage of absolute difference <10 mmHg in relation to IBP for SAP (90%), MAP (97%), and DAP (93%), compared with pelvic limb (60%, 97% and 82%, respectively) and tail OBP (54%, 92% and 77%, respectively).Conclusions and clinical relevanceThe tongue is a clinically useful site for measuring OBP in anesthetized Beagle dogs, providing reliable estimates of MAP and DAP. The tongue could replace other cuff placement sites and may be a relatively suitable site for assessing hypotension.     

Effects of ventilation and isoflurane end-tidal concentration on intracranial and cerebral perfusion pressures in horses

OBJECTIVE: To measure the effects of isoflurane end-tidal concentration and mode of ventilation (spontaneous vs controlled) on intracranial pressure (ICP) and cerebral perfusion pressure (CPP) in horses. ANIMAL: adult horses of various breeds. PROCEDURES: Anesthesia was induced and maintained with isoflurane in O2 in 6 healthy, unmedicated, adult horses. Using a subarachnoid strain gauge transducer, ICP was measured. Blood gas tensions and carotid artery pressures also were measured. Four isoflurane doses were studied, corresponding to the following multiples of the minimum alveolar concentration (MAC): 1.0 MAC, 1.2 MAC, 1.4 MAC, and 1.6 MAC. Data were collected during controlled ventilation and spontaneous ventilation at each dose. RESULTS: increasing isoflurane end-tidal concentration induced significant dose-dependent decreases in mean arterial pressure (MAP) and CPP but no change in ICR Hypercapnic spontaneous ventilation caused significant increases in MAP and ICR compared with normocapnic controlled ventilation; no change in CPP was observed. CONCLUSIONS AND CLINICAL RELEVANCE: Hypercapnia likely increases cerebral blood flow (CBF) by maintaining CPP in the face of presumed cerebral vasodilation in healthy anesthetized horses. The effect of isoflurane dose on CBF however, remains unresolved because it depends on the opposing influences of a decrease in CCP and cerebral vasodilation.     

Effect of ephedrine and phenylephrine on cardiopulmonary parameters in horses undergoing elective surgery

ObjectiveTo assess the cardiopulmonary effects of ephedrine and phenylephrine for management of isoflurane‐induced hypotension in horses.Study designProspective randomized clinical study.AnimalsFourteen isoflurane‐anesthetized horses undergoing digital palmar neurectomy.MethodsEphedrine (EPH group; 0.02 mg kg^?1 minute^?1; n = 7) or phenylephrine (PHE group; 0.002 mg kg^?1 minute^?1; n = 7) was administered to all horses when mean arterial pressure (MAP) was <60 mmHg. The infusions were ended when the target MAP was achieved, corresponding to a 50% increase over the pre‐infusion MAP (baseline). The horses were instrumented with an arterial catheter to measure blood pressure and allow the collection of blood for pH and blood‐gas analysis and a Swan‐Ganz catheter for measurement of cardiac output using thermodilution. Cardiopulmonary parameters were recorded at baseline and at 5, 30, 60 and 90 minutes after achieving the target MAP.ResultsIn both groups, the MAP and systemic vascular resistance (SVR) increased significantly at 5, 30, 60 and 90 minutes post infusion compared to baseline (p < 0.05). The EPH group had a significant increase in cardiac index (CI) and systemic oxygen delivery index at 5, 30, 60 and 90 minutes post infusion compared to baseline (p < 0.05) and compared to the PHE group (p < 0.05). The PHE group had significantly higher SVR and no decrease in oxygen extraction compared with the EPH group at 30, 60 and 90 minutes post infusion (p < 0.05). No significant differences in ventilatory parameters were observed between groups after the infusion.ConclusionsEphedrine increased the MAP by increasing CI and SVR. Phenylephrine increased MAP by increasing SVR but cardiac index decreased. Ephedrine resulted in better tissue oxygenation than phenylephrine.Clinical relevanceEphedrine would be preferable to phenylephrine to treat isoflurane‐induced hypotension in horses since it increases blood flow and pressure.     

Survey of resting blood pressure values in clinically normal horses

Resting coccygeal blood pressure values were measured, indirectly, on 296 horses (97 Thoroughbreds, 97 Standardbreds and 102 hacks). Blood pressure was found to vary with the class of horse examined; on average Thoroughbreds had significantly higher values than Standardbreds and hacks, whereas blood pressures of the last two groups were not significantly different. There was no demonstrable effect of sex, height or heart rate on blood pressure, but temperature and age did influence the value recorded. Mean (± sd) (n = 296) coccygeal uncorrected values (systolic pressure/diastolic pressure) were 112.1 ± 16.5/77.3 ± 14.3 mmHg. Allowing for bladder width to tail girth ratios used in each measurement, actual coccygeal pressures of 122.8 ± 18.6/71.0 ± 13.4 mmHg were determined. The latter corresponded to values of 149.4 ± 19.0/97.6 ± 14.0 mmHg, when corrected to heart (shoulder) level. Normal limits (defined as within 2.5th and 97.5th percentiles) for all horses, regardless of class, were 80 to 144 mmHg/49 to 105 mmHg for coccygeal uncorrected values and 86 to 159 mmHg/45 to 97 mmHg adjusted for bladder width to tail girth ratio.     

Clinical Outcome of 14 Obese,Laminitic Horses Managed with the Same Rehabilitation Protocol

A specific method of rehabilitation was used to manage obese horses with laminitis, and clinical outcome was evaluated after 5 to 20 months. Clinical data from 14 similar laminitis cases were statistically analyzed to evaluate response to rehabilitation. Data were analyzed using repeated measures or logistic regression methodologies. Each horse presented as obese and laminitic with no history of a systemic inflammatory disease. The rehabilitation method emphasized a mineral-balanced, low nonstructural carbohydrate diet; daily exercise; hoof trimming that minimized hoof wall loading; and sole protection in the form of rubber hoof boots and/or hoof casts. Distal phalanx alignment within the hoof capsule was significantly improved, and hoof wall thickness was significantly decreased (P < .0001) following treatment. Solar depth was significantly increased (P < .0015). Reduction of palmar angle measurements was detected in acutely and chronically affected horses. This treatment effect was statistically greater for horses with chronic laminitis than for horses with acute laminitis (P interaction < .0001). Horses were 5.5 times more likely to be sound post-treatment than before treatment. Daily exercise, dietary modification, and removal of ground reaction force from the hoof wall were foci of the rehabilitation program. Hoof care and husbandry as applied to these horses may be an effective method of rehabilitation of horses from obesity-associated laminitis.